Screening with the fecal occult blood test (FOBT) has been shown to reduce colorectal cancer incidence and mortality in randomized, controlled trials.
Although the test is simple, implementation requires adherence to specific techniques of testing and follow-up of abnormal results.
Dr Nadel and fellow researchers from Georgia, America undertook cross-sectional national surveys of primary care physicians and the public in order to examine how FOBT and follow-up are conducted in community practice across the United States.
The researchers used gathered information from the Survey of Colorectal Cancer Screening Practices in Health Care Organizations on 1,147 primary care physicians who ordered or performed FOBT.
In addition, the researchers analyzed data on 11,365 adults 50 years of age or older who responded to questions about FOBT in the 2000 National Health Interview Survey
The researchers analyzed self-reported data on details of FOBT implementation and follow-up of positive results.
|Sigmoidoscopy, rather than total colon examination, was commonly recommended to work up abnormal findings|
|Annals of Internal Medicine|
Although screening guidelines recommend home tests, the researchers found that 33% of physicians used only the less accurate method of single-sample in-office testing; another 41% used both types of test.
On follow-up of positive test results, the research team were able to show considerable nonadherence to guidelines, with 30% of physicians recommending repeating FOBT.
Furthermore the researchers found that sigmoidoscopy, rather than total colon examination, was commonly recommended to work up abnormal findings.
Nearly 1/3 of adults who reported having FOBT said they had only an in-office test, and nearly 1/3 of those who reported abnormal FOBT results reported no follow-up diagnostic procedures.
The research team commented that the data from the National Health Interview Survey may underestimate the prevalence of in-office testing and inadequate follow-up.
Dr Nadel concluded, "Mortality reductions demonstrated with FOBT in clinical trials may not be realized in community practice because of the common use of in-office tests and inappropriate follow-up of positive results."
"Education of providers and system-level interventions are needed to improve the quality of screening implementation."